trachoma

Definition

Trachoma, which is also called granular conjunctivitis or Egyptian ophthalmia, is a contagious, chronic inflammation of the mucous membranes of the eyes, caused by Chlamydia trachomatis. It is characterized by swelling of the eyelids, sensitivity to light, and eventual scarring of the conjunctivae and corneas of the eyes.

Description

Trachoma is a major cause of blindness in the world. It is found in the Far East, as well as countries with desert climates. In the United States, it is most common among certain Native Americans and in parts of Appalachia. The infection is highly contagious in its early stages. Blindness results from recurrent untreated infections.

The conjunctiva is the clear mucous membrane that lines the inside of the eyelid and covers the white part (sclera) of the eye. Conjunctivitis is an inflammation of the conjunctiva.

— Rebecca J. Frey, PhD

[New Latin trāchōma, from Greek trākhōma, from trākhus, rough.]

Definition

Trachoma, also called granular conjunctivitis or Egyptian ophthalmia, is a contagious, chronic inflammation of the mucous membranes of the eyes, caused by the bacterium Chlamydia trachomatis. It is characterized by swelling of the eyelids, sensitivity to light, and eventual scarring of the conjunctiva and cornea of the eye.

Description

Trachoma is a disease associated with poverty and unhygienic conditions. It is most common in hot, dry, dusty climates in the developing world where water is scarce and sanitation is poor. Trachoma is the most common infectious cause of blindness in the world. It has two stages. The first stage is active infection of the conjunctiva by the bacterium C. trachomatis. The conjunctiva is the clear mucous membrane that lines the inside of the eyelid and covers the white part (sclera) of the eye. This stage is highly contagious.

Acquiring trachoma does not provide immunity against re-infection, so repeat infections are the norm in many communities where the disease circulates continuously among family members. The frequency of active infection peaks in children ages three to five. In some communities, as many as 90 percent of children under age five are actively infected.

The second stage involves damage to the cornea, the transparent covering of the front of the eye. After repeated infections, the eyelids swell and the eyelashes begin to turn inward so that they scratch the cornea every time the individual blinks. This scratching is painful, and it scars the cornea, eventually resulting in the cornea becoming opaque. Individuals are often blind by middle age. Repeated, extended, untreated periods of infection are required for blindness to occur. An occasional, treated infection does not result in blindness.

Transmission

C. trachomatis is spread through direct contact. Infected young children serve as a reservoir of infection. The bacteria are then transmitted by close physical contact with family members and other caregivers. The bacteria are also spread through shared blankets, pillows, and towels. The bazaar fly Musca sorbens lays its eggs in human feces that can be contaminated with trachoma bacteria. These flies pick up bacteria on their bodies and can transmit them to humans.

Certain conditions promote the spread of trachoma bacteria. These include:

• poor personal hygiene
• poor body waste and trash disposal
• insufficient water supply for washing
• shared sleeping space
• close association with domestic animals

Demographics

Trachoma is widespread and present in a high percentage of the population in many parts of Africa, Iraq, Afghanistan, Burma, Thailand, and Viet Nam. Pockets of high trachoma infection also exist in southern Mexico, eastern Brazil, Ecuador, North Africa, India, China, Siberia, Indonesia, New Guinea, Borneo, and in Aboriginal communities in central Australia. Although trachoma is rare in developed countries, it is occasionally found in the United States in some Native American communities and in parts of Appalachia.

The greatest risk for contracting trachoma is having a family member with the disease. Although the disease shows no gender preference, two to three times more women eventually become blind than men, probably because they are the primary caretakers of small children who are infected. The active stage of the disease is most prevalent in children ages three to five. Blindness is most common in middle age. The World Health Organization (WHO) estimates that as of the early 2000s, between 360 and 500 million people are affected by trachoma worldwide and that six million people are blind because of the disease. In some heavily infected areas, up to 25 percent of the population becomes blind from this infection.

Causes and Symptoms

The early symptoms of trachoma include the development of follicles (small sacs) on the conjunctivae of the upper eyelids; pain; swollen eyelids; discharge; tearing; and sensitivity to light. If the infection is not treated, the follicles develop into large yellow or gray pimples, and small blood vessels develop inside the cornea. In most cases, both eyes are infected. The incubation period is about one week.

Repeated infections eventually lead to contraction and turning-in of the eyelids. The eyelashes then scratch the corneas and conjunctivae, every time the individual blinks. This scratching leads to scarring of the cornea, eventual blockage of the tear ducts, and blindness.

When to Call the Doctor

U.S. parents should call the doctor if they notice any discomfort or discharge from their child's eye, especially if they have recently traveled in areas where trachoma is common.

Diagnosis

Diagnosis is based on a combination of the patient's history (especially living or traveling in areas with high rates of trachoma) and examination of the eyes. The doctor looks for the presence of follicles or scarring. In developed countries where laboratory facilities are available, the doctor takes a small sample of cells from the child's conjunctivae and examines it, following a procedure called Giemsa staining, to confirm the diagnosis. In underdeveloped countries where medical resources are scarce, diagnosis is made based on an examination only.

Treatment

The preferred treatment is the oral antibiotic azithromycin (Zithromax). This medicine has replaced treatment with other antibiotics (usually tetracyclines), because only a single dose of azithromycin is required to clear the infection. Oral single dose treatment increases compliance. Everyone in the family should be treated at the same time, whether they show clinical signs of the disease or not, because transmission among family members is so common.

Individuals with complications from untreated or repeated infections require surgery. Surgery can be used for corneal transplantation or to correct eyelid deformities. It does not, however, prevent re-infection.

Prognosis

The prognosis for full recovery is excellent if the individual is treated promptly. If the infection has progressed to the stage of follicle development, prevention of blindness depends on the size of the follicles, the presence of additional bacterial infections, and the development of scarring. The longer the period of infection, the greater the risk of corneal scarring and blindness.

Prevention

Trachoma is a preventable disease. Prevention depends upon good hygiene and public health. The WHO has developed a program called SAFE, which aims to prevent blindness caused by trachoma. The elements of the program are surgery, antibiotic treatment, facial cleansing and improved personal hygiene, and environmental improvements. Despite this prevention program, permanent gains in controlling trachoma have been elusive.

Parental Concerns

In the United States, parents should check with the Centers for Disease Control (available online at www.cdc.gov) for advisories about the prevalence of trachoma if they are planning to travel with their children to underdeveloped countries.

Resources

Books

Bailey, Robin. "Eye Infections in the Tropics." In Infectious Diseases, 2nd ed. Edited by Jonathon Cohen and William Powderly. St. Louis: Mosby, 2003.

O'Brien, Terrence P. "Conjunctivitis." In Conn's Current Therapy, 56th ed. Edited by Robert E. Rakel. Philadelphia: W. B. Saunders Co., 2004.

Web Sites

Mabey, Denise, and Hugh Taylor. "Trachoma." eMedicine Medical Library, April 17, 2001. Available online at www.emedicine.com/0ph/topic118.htm Accessed August 1, 2004.

"Ophthalmologic Disorders: Trachoma." In The Merck Manual of Diagnosis and Therapy, 17th ed. Edited by Robert Berkow. Rahway, NJ: Merck Research Laboratories, 1999–2004. Available online at www.merck.com/mrkshared/mmanual/home.jsp (accessed October 18, 2004).

Organizations

Sight Savers International. c/o Chapel & York, PMB #293, 601 Pennsylvania Avenue, NW, Suite 900, South Building, Washington, DC 20004. Web site: www.sightsavers.org.

[Article by: Tish Davidson, A.M.]

Trachoma is a virulent form of conjunctivitis caused by Chlamydia trachomatis, a bacterial organism transmitted by flies that crawl into the eyes of small children. Direct transmission of the organism from fingers, damp towels, and other objects also occurs. Characteristically, reinfection is frequent in endemic regions; this leads to severe scarring and contractures, especially of the upper eyelid, and also causes blood vessels to invade the cornea, rendering it opaque. These effects of recurrent infection make trachoma a leading cause of blindness in those parts of the world where the condition is prevalent. These are predominantly poor, rural areas in hot, dry countries such as some nations in the Middle East and in arid regions of North Africa, India, Pakistan, and inland Australia.

Trachoma is responsible for about 6 million out of a total of 20 million cases of blindness worldwide, and it causes impaired vision in about 140 million people. Determined efforts have greatly reduced the incidence of new cases in the last two decades of the twentieth century, however. It is rare in industrially developed nations with good hygiene and effective fly control measures—such as screened windows. Trachoma is an exclusively human infection, so if vulnerable populations can be protected from exposure (e.g., if flies can be reduced or eliminated), transmission will cease and the infection can be prevented. These tactics have worked well in many regions, including among Australian Aborigines, where the prevalence was very high until control programs were established.

Control was achieved in Australia by an aggressive campaign led by Dr. Ida Mann, who devoted her life to this cause. Her methods comprised topical application of antiseptic and antibiotic eyedrops, disinfection and face washing, education about personal hygiene, and fly control programs. Initially this was a mass campaign, and it was reduced to individual case management as endemic conjunctivitis was brought under control. The same tactics have worked in the Middle East (e.g., among nomadic Bedouin populations in Saudi Arabia), and they are working well in endemic regions of India and Pakistan. The World Health Organization, with strong support from several foundations and nongovernmental organizations devoted to prevention of blindness, aspires to eliminate trachoma by 2020.

(SEE ALSO: Vision Disorders)

— JOHN M. LAST

Trachoma
Classification and external resources
Entropion and trichiasis secondary to trachoma
ICD-10	A71.
ICD-9	076
DiseasesDB	29100
MedlinePlus	001486
eMedicine	oph/118
MeSH	D014141

Trachoma (Ancient Greek: "rough eye") is an infectious eye disease, and the leading cause of the world's infectious blindness.^[1] Globally, 84 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease. Globally this disease results in considerable disability.

Contents 1 Signs and symptoms 2 Causes 3 Prevention 4 Prognosis 5 Epidemiology 6 History 7 References 8 See also 9 External links

Signs and symptoms

The bacterium has an incubation period of 5 to 12 days, after which the affected individual experiences symptoms of conjunctivitis, or irritation similar to "pink eye." Blinding endemic trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva. Without reinfection, the inflammation will gradually subside.^[2]

The conjunctival inflammation is called “active trachoma” and usually is seen in children, especially pre school children. It is characterized by white lumps in the undersurface of the upper eye lid (conjunctival follicles or lymphoid germinal centres) and by non-specific inflammation and thickening often associated with papillae. Follicles may also appear at the junction of the cornea and the sclera (limbal follicles). Active trachoma will often be irritating and have a watery discharge. Bacterial secondary infection may occur and cause a purulent discharge.

The later structural changes of trachoma are referred to as “cicatricial trachoma”. These include scarring in the eye lid (tarsal conjunctiva) that leads to distortion of the eye lid with buckling of the lid (tarsus) so the lashes rub on the eye (trichiasis). These lashes will lead to corneal opacities and scarring and then to blindness. In addition, blood vessels and scar tissue can invade the upper cornea (pannus). Resolved limbal follicles may leave small gaps in pannus (Herbert’s Pits).

The World Health Organization recommends a simplified grading system for trachoma.^[3] The Simplified WHO Grading System is summarized below:

• Trachomatous inflammation, follicular (TF) – Five or more follicles of >0.5 mm on the upper tarsal conjunctiva

• Trachomatous inflammation, intense (TI) – Papillary hypertrophy and inflammatory thickening of the upper tarsal conjunctiva obscuring more than half the deep tarsal vessels

• Trachomatous trichiasis (TT) – At least one ingrown eyelash touching the globe, or evidence of epilation (eyelash removal)

• Corneal opacity (CO) – Corneal opacity blurring part of the pupil margin

Further symptoms include:

• Eye discharge
• Swollen eyelids
• Trichiasis (turned-in eyelashes)
• Swelling of lymph nodes in front of the ears
• Corneal scarring
• Further ear, nose and throat complications.

Causes

Trachoma is caused by Chlamydia trachomatis and it is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with fomites (inanimate objects), such as towels and/or washcloths, that have had similar contact with these secretions. Flies can also be a route of mechanical transmission. Untreated, repeated trachoma infections result in entropion—a painful form of permanent blindness when the eyelids turn inward, causing the eyelashes to scratch the cornea. Children are the most susceptible to infection due to their tendency to easily get dirty, but the blinding effects or more severe symptoms are often not felt until adulthood.

Blinding endemic trachoma occurs in areas with poor personal and family hygiene. Many factors are indirectly linked to the presence of trachoma including lack of water, absence of latrines or toilets, poverty in general, flies, close proximity to cattle, crowding and so forth.^[2][4] However, the final common pathway seems to be the presence of dirty faces in children that facilitates the frequent exchange of infected ocular discharge from one child’s face to another. Most transmission of trachoma occurs within the family.^[2]

Prevention

Although trachoma was eliminated from much of the developed world in the last century, this disease persists in many parts of the developing world particularly in communities without adequate access to water and sanitation. In many of these communities, women are three times more likely than men to be blinded by the disease, due to their roles as caretakers in the family.^[5]

Without intervention, trachoma keeps families shackled within a cycle of poverty, as the disease and its long-term effects are passed from one generation to the next.

National governments in collaboration with numerous non-profit organizations implement trachoma control programs using the WHO-recommended SAFE strategy, which includes:

• Surgery to correct advanced stages of the disease;
• Antibiotics to treat active infection, using Zithromax (azithromycin) donated by Pfizer Inc through the International Trachoma Initiative;
• Facial cleanliness to reduce disease transmission;
• Environmental change to increase access to clean water and improved sanitation.

Surgery: For individuals with trichiasis, a bilamellar tarsal rotation procedure is warranted to direct the lashes away from the globe.^[6] Early intervention is beneficial as the rate of recurrence is higher in more advanced disease.^[7]

Antibiotic therapy: WHO Guidelines recommend that a region should receive community-based, mass antibiotic treatment when the prevalence of active trachoma among one to nine year-old children is greater than 10 percent.^[8] Subsequent annual treatment should be administered for three years, at which time the prevalence should be reassessed. Annual treatment should continue until the prevalence drops below five percent. At lower prevalences, antibiotic treatment should be family-based.

Antibiotic selection: (single oral dose of 20 mg/kg) or topical tetracycline (one percent eye ointment twice a day for six weeks). Azithromycin is preferred because it is used as a single oral dose. Although it is expensive, it is generally used as part of the international donation program organized by Pfizer through the International Trachoma Initiative.^[9] Azithromycin can be used in children from the age of six months and in pregnancy.^[2]

Facial cleanliness: Children with grossly visible nasal discharge, ocular discharge, or flies on their faces are at least twice as likely to have active trachoma as children with clean faces.^[2] Intensive community-based health education programs to promote face-washing can significantly reduce the prevalence of active trachoma, especially intense trachoma (TI). . If somebody is already infected washing one’s face is strongly encouraged, especially a child, in order to prevent re-infection. ((Prevention-Trachoma. 18 July 2008. 24 March 2009 <http://mayoclinic.com/health/trachoma/DS00776/DSECTION=prevention>.))

Environmental improvement: Modifications in water use, fly control, latrine use, health education and proximity to domesticated animals have all been proposed to reduce transmission of C. trachomatis. These changes pose numerous challenges for implementation. It seems likely that these environmental changes ultimately impact on the transmission of ocular infection by means of lack of facial cleanliness.^[2] Particular attention is required for environmental factors that limit clean faces.

Prognosis

If not treated properly with oral antibiotics, the symptoms may escalate and cause blindness, which is the result of ulceration and consequent scarring of the cornea. Surgery may also be necessary to fix eyelid deformities.

Epidemiology

Disability-adjusted life year for trachoma per 100,000 inhabitants in 2002.

     no data      less than 10      10-20      20-40      40-60      60-80      80-100      100-200      200-300      300-400      400-500      500-600      more than 600

History

The disease is one of the earliest recorded eye afflictions, having been identified in Egypt as early as 15 B.C.^[2]

Its presence was also recorded in ancient China and Mesopotamia. Trachoma became a problem as people moved into crowded settlements or towns where hygiene was poor. It became a particular problem in Europe in the 19th Century. After the Egyptian Campaign (1798 – 1802) and the Napoleonic Wars (1798 – 1815), trachoma was rampant in the army barracks of Europe and spread to those living in towns as troops returned home. Stringent control measures were introduced and by the early 20th Century, trachoma was essentially controlled in Europe, although cases were reported up until the 1950s.^[2] Today, most victims of trachoma live in underdeveloped and poverty-stricken countries in Africa, the Middle East, and Asia.

Rare in the United States, the disease can be treated with antibiotics and prevented with adequate hygiene and education. According to the Centers for Disease Control, "No national or international surveillance [for trachoma] exists. Blindness due to trachoma has been eliminated from the United States. The last cases were found among Native American populations and in Appalachia, and those in the boxing, wrestling, and sawmill industries (prolonged exposure to combinations of sweat and sawdust often lead to the disease). In the late 19th century and early 20th century, trachoma was the main reason for an immigrant coming through Ellis Island to be deported."^[10]

In 1913, President Woodrow Wilson signed an act designating funds for the eradication of the disease.^[11][12] The people that went through Ellis Island had to be checked for trachoma. By the late 1930s, a number of ophthalmologists reported success in treating trachoma with sulfonamide antibiotics.^[13] In 1948, Vincent Tabone (who was later to become the President of Malta) was entrusted with the supervision of a campaign in Malta to treat trachoma using sulfonamide tablets and drops.^[14]

Although by the 1950s, trachoma had virtually disappeared from the industrialized world, thanks to improved sanitation and overall living conditions, it continues to plague the developing world. This potentially blinding disease remains endemic in the poorest regions of Africa, Asia, and the Middle East and in some parts of Latin America and Australia. Currently, 8 million people are visually impaired as a result of trachoma, and 84 million suffer from active infection.

References

1. ^ The Global Network for Neglected Tropical Diseases (The Sabin Vaccine Institute) - Trachoma
2. ^ ^{a b c d e f g h} Taylor, Hugh (2008). Trachoma: A Blinding Scourge from the Bronze Age to the Twenty-first Century. Centre for Eye Research Australia. ISBN 0-9757695-9-6. 
3. ^ Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR (1987). "A simple system for the assessment of trachoma and its complications". Bull. World Health Organ. 65 (4): 477–83. PMID 3500800. 
4. ^ Wright HR, Turner A, Taylor HR (June 2008). "Trachoma". Lancet 371 (9628): 1945–54. doi:10.1016/S0140-6736(08)60836-3. PMID 18539226. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(08)60836-3. 
5. ^ What is Trachoma? International Trachoma Initiative.
6. ^ Reacher M, Foster A, Huber J. “Trichiasis Surgery for Trachoma. The Bilamellar Tarsal Rotation Procedure.” 1993; World Health Organization, Geneva: WHO/PBL/93.29.
7. ^ Burton MJ, Kinteh F, Jallow O, et al. (October 2005). "A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia". Br J Ophthalmol 89 (10): 1282–8. doi:10.1136/bjo.2004.062489. PMID 16170117. http://bjo.bmj.com/cgi/pmidlookup?view=long&pmid=16170117. 
8. ^ Solomon, AW; Zondervan M, Kuper H, et al. (2006). "Trachoma control: a guide for programme managers.". World Health Organization. http://www.who.int/blindness/publications/tcm%20who_pbd_get_06_1.pdf. 
9. ^ Mariotti SP (November 2004). "New steps toward eliminating blinding trachoma". N. Engl. J. Med. 351 (19): 2004–7. doi:10.1056/NEJMe048205. PMID 15525727. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=15525727&promo=ONFLNS19. 
10. ^ Disease Listing, Trachoma, Technical Information | CDC Bacterial, Mycotic Diseases.
11. ^ Allen SK, Semba RD (2002). "The trachoma menace in the United States, 1897-1960". Surv Ophthalmol 47 (5): 500–9. doi:10.1016/S0039-6257(02)00340-5. PMID 12431697. http://linkinghub.elsevier.com/retrieve/pii/S0039625702003405. 
12. ^ Leupp, Constance D. (August 1914). "Removing The Blinding Curse Of The Mountains: How Dr. McMullen, Of The Public Health Service Is Organizing The War Against Trachoma In The Appalachians". The World's Work: A History of Our Time XLIV (2): 426-430. http://books.google.com/books?id=zegeQtMn9JsC&pg=PA426. Retrieved 2009-08-04. 
13. ^ Thygeson P (1939). "The Treatment of Trachoma with Sulfanilamide: A Report of 28 Cases". Trans Am Ophthalmol Soc 37: 395–403. PMID 16693194. PMC 1315791. http://www.pubmedcentral.gov/picrender.fcgi?artid=1315791&blobtype=pdf. 
14. ^ Ophthalmology in Malta, C. Savona Ventura, University of Malta, 2003.

See also

• Keratoconjunctivitis
• Chlamydial infection

External links

• CDC Disease Info trachoma_t
• International Trachoma Initiative
• New York Times article Preventable Disease Blinds Poor in Third World Published: March 31, 2006
• Photographs of trachoma patients

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v • d • e Eye disease · pathology of the eye (H00-H59, 360-379) Adnexa eyelid: inflammation (Stye, Chalazion, Blepharitis) · Entropion · Ectropion · Lagophthalmos · Blepharochalasis · Ptosis · Blepharophimosis · Xanthelasma · eyelash (Trichiasis, Madarosis) lacrimal system: Dacryoadenitis · Epiphora · Dacryocystitis · Xerophthalmia orbit: Exophthalmos · Enophthalmos conjunctiva: Conjunctivitis (Allergic conjunctivitis) · Pterygium · Pinguecula · Subconjunctival hemorrhage Globe Fibrous tunic sclera: Scleritis cornea: Keratitis (Herpetic keratitis, Acanthamoeba keratitis, Fungal keratitis) · Corneal ulcer · Snow blindness · Thygeson's superficial punctate keratopathy · Corneal dystrophy (Fuchs', Meesmann) · Keratoconus · Keratoconjunctivitis sicca · Arc eye · Keratoconjunctivitis · Corneal neovascularization  · Kayser-Fleischer ring · Arcus senilis · Band keratopathy Vascular tunic Iris and ciliary body Iritis · Uveitis (Intermediate uveitis) · Iridocyclitis · Hyphema · Rubeosis iridis · Persistent pupillary membrane · Iridodialysis · Synechia Choroid Choroideremia · Choroiditis (Chorioretinitis) Lens Cataract · Aphakia · Ectopia lentis Retina Retinitis (Chorioretinitis, Cytomegalovirus retinitis) · Retinal detachment · Retinoschisis · Ocular ischemic syndrome/Central retinal vein occlusion · Retinopathy (Bietti's crystalline dystrophy, Coats disease, Diabetic retinopathy, Hypertensive retinopathy, Retinopathy of prematurity) · Macular degeneration · Retinitis pigmentosa · Retinal haemorrhage · Central serous retinopathy · Macular edema · Epiretinal membrane · Macular pucker · Vitelliform macular dystrophy · Leber's congenital amaurosis · Birdshot chorioretinopathy Other Glaucoma/Ocular hypertension · Floater · Leber's hereditary optic neuropathy · Red eye · Keratomycosis · Phthisis bulbi Pathways Optic nerve and visual pathways Optic neuritis · Papilledema · Optic atrophy · Leber's hereditary optic neuropathy · Dominant optic atrophy · Optic disc drusen · Glaucoma · Toxic and nutritional optic neuropathy · Anterior ischemic optic neuropathy Ocular muscles, binocular movement, accommodation and refraction Paralytic strabismus: Ophthalmoparesis · Progressive external ophthalmoplegia · Palsy (III, IV, VI) · Kearns-Sayre syndrome Other strabismus: Esotropia/Exotropia · Hypertropia · Heterophoria (Esophoria, Exophoria) · Brown's syndrome · Duane syndrome Other binocular: Conjugate gaze palsy · Convergence insufficiency · Internuclear ophthalmoplegia · One and a half syndrome Refractive error: Hyperopia/Myopia · Astigmatism · Anisometropia/Aniseikonia · Presbyopia Visual disturbances and blindness Amblyopia · Leber's congenital amaurosis  · Subjective (Asthenopia, Hemeralopia, Photophobia, Scintillating scotoma) · Diplopia · Scotoma · Anopsia (Binasal hemianopsia, Bitemporal hemianopsia, Homonymous hemianopsia, Quadrantanopia) · Color blindness (Achromatopsia, Dichromacy, Monochromacy) · Nyctalopia (Oguchi disease) · Blindness/Low vision Pupil Anisocoria · Argyll Robertson pupil · Marcus Gunn pupil · Adie syndrome · Miosis · Mydriasis · Cycloplegia Other Nystagmus Eye infections Trachoma · Onchocerciasis eye navs: anat/adnexa anat/pathways/physio/dev, noncongen/congen/neoplasia, eponymous signs, proc

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Dansk (Danish)
n. - ægyptisk øjensyge

Nederlands (Dutch)
oogbindvlies- ontsteking

Français (French)
n. - trachome

Deutsch (German)
n. - Trachom, Granulose (der Bindehaut)

Ελληνική (Greek)
n. - (παθολ.) τράχωμα

Italiano (Italian)
tracoma

Português (Portuguese)
n. - tracoma (m), conjuntivite granulosa (f)

Русский (Russian)
трахома (глазное заболевание)

Español (Spanish)
n. - tracoma

Svenska (Swedish)
n. - trakom (med.)

中文（简体）(Chinese (Simplified))
沙眼, 粒性结膜炎

中文（繁體）(Chinese (Traditional))
n. - 沙眼, 粒性結膜炎

한국어 (Korean)
n. - 트라코마, 과립성 결막염

日本語 (Japanese)
n. - トラコーマ

العربيه (Arabic)
‏(الاسم) ألخثار, التراخوما‏

עברית (Hebrew)
n. - ‮גרענת, טרכומה‬

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